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Objective: Magnesium sulfate is standard of care for prevention of eclampsia in women with preeclampsia with severe features. The American College of Obstetrics and Gynecology endorses its use throughout labor, delivery and the immediate postpartum period. Some providers pause magnesium sulfate infusion preoperatively due to concern for increased risk of uterine atony and postpartum hemorrhage. Using a non-inferiority analysis, we investigated the effect of interrupted versus continuous infusion of magnesium sulfate on postpartum hemorrhage in women with preeclampsia with severe features undergoing cesarean delivery., Study Design: Retrospective non-inferiority cohort study of women with preeclampsia with severe features treated with magnesium sulfate undergoing cesarean delivery with singleton pregnancies at tertiary care hospital from 2013 to 2018. The primary outcome was postpartum hemorrhage. Secondary outcomes included estimated blood loss, change in hematocrit and a composite of postpartum hemorrhage severity, including transfusion of blood products, use of more than one uterotonic and additional surgical interventions., Results: Of 249 women, magnesium sulfate infusion was interrupted in 171 (69%) and continued in 78 (31%). Women with interrupted magnesium sulfate infusion were more likely to be Caucasian (73% vs 67%, p  = .024), have chronic hypertension (23% vs 1%, p  < .001), labor prior to cesarean delivery (84% vs 55%, p  < .001), undergo primary cesarean delivery (86% vs 67%, p  = .005), and experience shorter surgical time (50 vs 55 min, p  = .026). The rate of postpartum hemorrhage for those receiving interrupted magnesium sulfate infusion (9.9%) and continuous magnesium sulfate infusion (10.2%) was similar, falling within the non-inferiority margin (absolute difference 0.3%, 95% CI -7.8 to 8.4%, p  = .88). There were no significant differences in the secondary outcomes., Conclusion: Interrupted magnesium sulfate infusion is non-inferior to continued magnesium sulfate infusion for rates of postpartum hemorrhage in women with preeclampsia with severe features undergoing cesarean delivery.

Objective: Pregnant women have been historically excluded from clinical trials for nonobstetric conditions, even during prior epidemics. The objective of this review is to describe the current state of research for pregnant women during the coronavirus disease 2019 (COVID-19) pandemic., Study Design: We conducted a search of international trial registries for trials relating to the novel coronavirus. The eligibility criteria for each trial were reviewed for inclusion/exclusion of pregnant women. Relevant data were extracted and descriptive statistics were calculated for individual and combined data. The total number of trials from each registry were compared, as well as the proportions of pregnancy-related trials within each., Results: Among 621,370 trials in the World Health Organization International Clinical Trials Registry, 927 (0.15%) were COVID-19 related. Of those, the majority (52%) explicitly excluded pregnancy or failed to address pregnancy at all (46%) and only 16 (1.7%) were pregnancy specific. When categorized by region, 688 (74.2%) of COVID-19 trials were in Asia, followed by 128 (13.8%) in Europe, and 66 (7.2%) in North America. Of the COVID-19 trials which included pregnant women, only three were randomized-controlled drug trials., Conclusion: Approximately 1.7% of current COVID-19 research is pregnancy related and the majority of trials either explicitly exclude or fail to address pregnancy. Only three interventional trials worldwide involved pregnant women. The knowledge gap concerning the safety and efficacy of interventions for COVID-19 created by the exclusion of pregnant women may ultimately harm them. While "ethical" concerns about fetal exposure are often cited, it is in fact unethical to habitually exclude pregnant women from research., Key Points: · Pregnancy was excluded from past pandemic research.. · Pregnancy is being excluded from COVID-19 research.. · Exclusion of pregnant women is potentially harmful.., Competing Interests: None declared., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

We use laser photoacoustic spectroscopy to obtain overtone spectra at three through six quanta of O-H stretch excitation (3nu(OH)-6nu(OH)) for methyl hydroperoxide (MeOOH). Extending the spectral regions beyond our previous work reveals new features that can be attributed to transitions involving torsion about the O-O bond. Experimental spectral profiles (3nu(OH)-6nu(OH)) and cross sections (3nu(OH)-5nu(OH)) at room temperature show a good agreement with the simulated spectra that we obtain from ab initio calculations employing a vibration-torsion model at 298 K. A Birge-Sponer analysis yields experimental values for the O-H stretch frequency (omega=3773+/-15 cm(-1)) and anharmonicity (omegax=94+/-3 cm(-1)). We also detect OH radicals by laser-induced fluorescence and present photodissociation action spectra of MeOOH in the regions of 4nu(OH) and 5nu(OH). While the spectral profile at 5nu(OH) mimics the photoacoustic spectrum, the peak intensity for transitions to torsionally excited states is relatively more intense in the action spectrum at 4nu(OH), reflecting the fact that the 4nu(OH) excitation energy is below the literature dissociation energy (D0=42.6+/-1 kcal mol(-1)) so that features in the action spectrum come from thermally populated excited states. Finally, we use our calculations to assign contributions to individual peaks in the room-temperature spectra and relate our findings to a recent dynamics study in the literature.